Response of exhaled nitric oxide to inhaled corticosteroids in patients with stable COPD: A systematic review and meta-analysis.

INTRODUCTION: To our knowledge, no meta-analysis has investigated the response of FeNO levels to corticosteroid treatment in ex-smokers with chronic obstructive pulmonary disease (COPD). OBJECTIVES: This meta-analysis assessed the potential role of fraction of exhaled nitric oxide (FeNO) as a biomarker for corticosteroid response in ex-smokers with stable COPD. METHODS: Medline, Cochrane, EMBASE, Google Scholar databases were searched until November 5, 2014 using the following terms: corticosteroid, chronic obstructive pulmonary disease, COPD, nitric oxide, NO, exhaled nitric oxide. Only randomized controlled trials (RCT) or two-arm prospective studies were included. The primary outcome measure was FeNO before and after treatment with inhaled corticosteroids (ICS) in ex-smokers with COPD. Sensitivity analysis was also performed. RESULTS: Five studies were included in the analysis with a total of 171 COPD patients. All five studies included 125 ex-smokers and two of these also included 46 current smokers. There was a significant decrease of FeNO in ex-smoking COPD patients following inhaled corticosteroid treatment (-7.51, 95% CI: -11.51 to -3.51; P =0.003); and in a population of subjects that included both smokers and ex-smokers (-1.99, 95% CI: -3.41 to -0.56; P =0.006). CONCLUSION: Our findings indicate that FeNO levels significantly decreased with corticosteroid treatment in ex-smokers with COPD. Additional studies are required to evaluate whether concurrent smoking has significant effect on FeNO response to ICS.

Association of chronic obstructive pulmonary disease and postresection lung cancer survival: a systematic review and meta-analysis.

Patients with lung cancer often have chronic obstructive pulmonary disease (COPD), but the impact of COPD on postresection survival of patients with lung cancer is unclear. This study evaluated the impact of COPD on survival of patients with lung cancer following pulmonary resection. Databases searched included PubMed, Cochrane, and Embase until March 2016. Study outcomes were overall survival and pulmonary complication rate (pneumonia, bronchial fistula, and prolonged mechanical ventilation). 6 studies with a total of 3761 patients were included. The presence of COPD was associated with lower overall survival, increased frequency of pneumonia, and prolonged mechanical ventilation (p values ≤0.001). COPD had no influence on bronchial fistula development (p=0.098). In summary, COPD was associated with poorer survival and an increased frequency of certain adverse events in patients with lung cancer following resection.

Comparison of cardiovascular co-morbidities and CPAP use in patients with positional and non-positional mild obstructive sleep apnea.

BACKGROUND: This retrospective cohort study aimed to determine if there are differences in cardiovascular co-morbidities, blood pressure (BP) and continuous positive airway pressure (CPAP) use between patients with positional-dependent and nonpositional-dependent obstructive sleep apnea (OSA). METHODS: Patients who were referred for overnight polysomnography for suspected OSA between 2007 and 2011 were screened. A total of 371 patients with OSA were included for analysis and divided into six groups according to positional-dependency and severity of OSA: positional mild (n = 52), positional moderate (n = 29), positional severe (n = 24), non-positional mild (n = 18), non-positional moderate (n = 70) and non-positional severe group (n = 178). The six groups were compared for anthropometric and polysomnographic variables, presence of cardiovascular co-morbidities, morning and evening BP and the changes between evening and morning BP, and CPAP device usage patterns. RESULTS: Demographic and anthropometric variables showed non-positional severe OSA had poor sleep quality and higher morning blood pressures. Positional mild OSA had the lowest cardiovascular co-morbidities. Overall CPAP acceptance was 45.6%. Mild OSA patients had the lowest CPAP acceptance rate (10%), followed by moderate group (37.37%) and severe group (61.88%, P < 0.001). However, the significant difference in CPAP acceptance across OSA severity disappeared when the data was stratified by positional dependency. CONCLUSIONS: This study found that positional mild OSA had less cardiovascular co-morbidities compared with subjects with positional severe OSA. Independent of posture, CPAP acceptance in patients with mild OSA was low, but CPAP compliance was similar in CPAP acceptors regardless of posture dependency of OSA. Since there are increasing evidences of greater cardiovascular risk for untreated mild OSA, improving CPAP acceptance among mild OSA patients may be clinically important regardless of posture dependency.

Risk factors of pneumothorax after CT-guided coaxial cutting needle lung biopsy through aerated versus nonaerated lung.

PURPOSE: To compare the risk factors of developing a pneumothorax after computed tomography-guided lung biopsy in cases in which aerated lung is traversed and in cases in which aerated lung is not traversed. MATERIALS AND METHODS: The records of 381 patients from July 2005-December 2009 were retrospectively reviewed. Multivariable analysis of patient demographic characteristics, lung lesion characteristics, and biopsy procedure details was performed with respect to the development of pneumothorax. RESULTS: Among 381 patients, 249 biopsies traversed aerated lung tissue, and 132 biopsies did not traverse aerated lung tissue. Patients in whom aerated lung tissue was traversed had a significantly higher rate of pneumothorax. When aerated lung was not traversed, lesion size (≤ 2 cm vs > 2 cm; P = .025) and pleural-lesion angle (odds ratio = 1.033/degree; P = .004) were associated with pneumothorax. When aerated lung was traversed, location (middle vs upper; P = .009) and a transfissure approach (yes vs no; P = .001) were associated with pneumothorax. CONCLUSIONS: When aerated lung was not traversed, lesion size and pleural-lesion angle were associated with pneumothorax, and when aerated lung was traversed, location and a transfissure approach were associated with pneumothorax.

Risk factors for pulmonary tuberculosis in patients with chronic obstructive airway disease in Taiwan: a nationwide cohort study.

BACKGROUND: An association between chronic obstructive pulmonary disease (COPD) and tuberculosis (TB) has been described, mainly due to smoking and corticosteroid use. Whether inhaled corticosteroid (ICS) therapy is associated with an increased risk of TB remains unclear. METHODS: We selected COPD cases by using six diagnostic scenarios and control subjects from a nationwide health insurance database, and applied time-dependent Cox regression analysis to identify the risk factors for TB. RESULTS: Among 1,000,000 beneficiaries, 23,594 COPD cases and 47,188 non-COPD control subjects were selected. Cox regression analysis revealed that age, male gender, diabetes mellitus, end-stage renal disease, and cirrhosis, as well as COPD (hazard ratio = 2.468 [2.205-2.762]) were independent risk factors for TB. Among the COPD cases, those who developed TB received more oral corticosteroids and oral ß-agonists. Time-dependent Cox regression analysis revealed that age, male gender, diabetes mellitus, low income, oral corticosteroid dose, and oral ß-agonist dose, but not ICS dose, were independent risk factors for TB. The identified risk factors and their hazard ratios were similar among the COPD cases selected using different scenarios. CONCLUSION: Keeping a high suspicion and regularly monitoring for the development of pulmonary TB in COPD patients are necessary, especially for those receiving higher doses of oral corticosteroids and other COPD medications. Although ICS therapy has been shown to predispose COPD patients to pneumonia in large randomized clinical trials, it does not increase the risk of TB in real world practice.

Factors affecting CPAP acceptance in elderly patients with obstructive sleep apnea in Taiwan.

BACKGROUND: The prevalence of obstructive sleep apnea (OSA) increases with age. Treatment often includes CPAP. CPAP adherence is correlated with disease severity and symptoms. We hypothesized that CPAP acceptance rates in elderly patients with OSA would be lower than in younger patients with OSA, and examined factors associated with CPAP acceptance. METHODS: We reviewed the charts of 315 subjects with OSA (apnea-hypopnea index ≥ 5 events/h) who were treated at our hospital from 2008 to 2011 with CPAP therapy. All underwent CPAP titration testing before CPAP prescription. Subjects were grouped by age: young (25-40 y, n = 35), middle-age (41-65 y, n = 169), and elderly (> 65 y, n = 111). Demographic variables, excessive daytime sleepiness, overnight polysomnography study variables, CPAP acceptance, and CPAP adherence were compared. Regression analysis was performed to identify factors associated with acceptance. RESULTS: The elderly subjects had less excessive daytime sleepiness and less pronounced alterations in overnight polysomnography variables than the subjects in the other groups, but had more cardiovascular comorbidities. The CPAP acceptance rate (overall 125/315, 39.7%) was significantly lower in the elderly group, compared with the younger group (31.5% vs 60%, P = .01). CPAP acceptance was associated with fewer comorbidities, higher excessive daytime sleepiness, and higher apnea-hypopnea index, but not age. CPAP adherence was not associated with age. CONCLUSIONS: CPAP acceptance is low in elderly patients in Taiwan. CPAP acceptance, instead of CPAP adherence, is the critical issue with elderly patients with OSA.

Fish fin aspiration: an unusual type of lower airway foreign body in a Chinese adult.

Foreign body aspiration into the lower airway is rare in adults, and typically occurs in individuals of advanced age or with underlying neurological or medical conditions. The most common type of lower airway foreign body is organic substances, in particular chicken or fish bones. In many patients a history of an acute choking event is not found, and symptoms are non-specific and may be attributed to other medical conditions. Herein we report the unique case of an 80-year-old Chinese woman who aspirated a fish fin that was undiagnosed for 3 years.

Association of body mass index with exercise cardiopulmonary responses in lung function-matched patients with chronic obstructive pulmonary disease.

BACKGROUND AND OBJECTIVES: Lung function is traditionally used to define the severity of chronic obstructive pulmonary disease (COPD). However, this does not exclude other factors. This study investigated the influence of body mass index (BMI) on exercise responses and quality of life in patients with COPD matched for values of forced expiratory volume in 1 second (FEV(1)). METHODS: Underweight, normal-weight, and overweight patients with COPD, matched for FEV(1), were studied. All patients were evaluated by spirometry, a cardiopulmonary exercise test, respiratory muscle strength, and, St. George's Respiratory Questionnaire (SGRQ). RESULTS: The baseline characteristics and mean FEV(1) of the 3 groups were similar (P > .05). Respiratory muscle strengths and SGRQ scores were lowest in underweight patients (P < .05). In terms of exercise response, the lowest oxygen uptake at anaerobic threshold and peak exercise, the highest ventilatory equivalent, and the lowest oxygen pulse were evident in underweight patients (P < .05). CONCLUSIONS: Underweight patients with COPD had lower respiratory muscle strength, impaired exercise capacity, earlier anaerobic metabolism, ineffective ventilation, and poorer quality of life.

Factors that affect the diagnostic yield of endobronchial ultrasonography-assisted transbronchial lung biopsy.

BACKGROUND: Endobronchial ultrasound (EBUS) is a relatively noninvasive procedure used to diagnose and stage lung cancer. Although EBUS-guided transbronchial lung biopsy (TBLB) procedures for peripheral lesions have higher diagnostic yields than traditional TBLB or fluoroscopy-assisted TBLB, the diagnostic yield is not 100%, and the reasons for this are not clear. SUBJECTS AND METHODS: This retrospective study assessed what characteristics influence the diagnostic yield of EBUS-guided TBLB. EBUS was used to locate a single peripheral lung nodule or mass, and the lesion was biopsied and pathologically characterized. Parameters that were evaluated included patient demographics, lesion location, ease of tumor sampling, location of the EBUS probe relative to the lesion, pathological volume, tumor cell type, and whether physicians were under supervision. RESULTS: Thirty-nine patients received EBUS-guided TBLB, which correctly identified 76.9% of the patients as having lung cancer. For the remaining patients, subsequent surgery indicated their tumors were malignant. Univariate logistic regression modeling indicated that only the location of the probe relative to the lesion was significantly associated with diagnostic yield of EBUS-guided TBLB. When the probe was directly within the lesion, it was 8.17 times (odds ratio 8.17; 95% confidence interval 1.41, 47.22; P=.019) more likely to have a successful TBLB than when the probe was adjacent to the lesion. CONCLUSIONS: In this study, the position of the probe relative to a peripheral lung lesion was associated with the diagnostic yield of EBUS-guided TBLB. Larger prospective studies are required to further assess what influences the diagnostic yield of this technology.